Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is a localized separation of a segment of bone and cartilage from the surrounding, normal bone and cartilage. If the bony part of the fragment becomes necrotic (dead),there will be no healing and there will be a complete separation of the fragment from the surrounding tissue. In 75% of cases the lesion is localized to the medial femoral condyle of the knee. It can also occur in the ankle, the elbow, the shoulder, and the hip joints. It can start from the age of 5–10 years, up to 40 years, but is more common at 10–20 years of age. It is 2–3 times more common in males. OCD can be divided into a juvenile form and an adult form. The juvenile form affects children and adolescents up to the closure of the epiphyses (growth zones); the adult form also affects adolescents after closure of the epiphyses. The younger the patient and the earlier the detection of OCD, the better are the results of treatment and the prognosis.

Mechanism of injury

Many etiologies have been proposed for OCD. Trauma or repetitive microtrauma with impingement of the tibial spine against the lateral aspect of the medial femoral condyle has been proposed as a cause in the knee joint. Distortions of a joint may be common, as well as repetitive overload as in the ankle and elbow• in both small and large defects try autologous chondrocyte transplantation or other appropriate techniques.


Healing and return to sport

In the juvenile form after conservative treatment, an evaluation with MRI, or bone scan, or arthroscopy should be performed before sport is resumed. Regaining muscle strength and mobility of the joint is important. In the adult form and/or after surgery, an MRI or arthroscopy should be performed before any return to sporting activities.


Prognosis

The prognosis is better in the juvenile form, especially if it is treated early. An OCD in a weightbearing condyle will, within 20–30 years, progress to osteoarthritis of the knee in 80% of cases.


Diseases of joints

The articular surfaces of joints are covered with cartilage which has no blood supply and, therefore, does not heal well when injured. Articular cartilage reduces friction and increases shock absorption between bones. The membrane lining the joint capsule secretes synovial fluid, which supplies the nutrients required by the cartilage and also serves to reduce friction during joint movements.

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